Individual
JILL WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED,LCPC
Contact information
Practice address
56 ELM ST, TOPSHAM, ME 04086-1417
(207) 449-5729
(866) 531-8540
Mailing address
56 ELM ST, TOPSHAM, ME 04086-1417
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CC00000733
ME
Other
Enumeration date
03/24/2010
Last updated
03/24/2010
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